Healthcare Provider Details

I. General information

NPI: 1265200141
Provider Name (Legal Business Name): SUSAN LAURSEN MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSY LAURSEN MSW, LICSW

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 METRO BLVD STE 550
EDINA MN
55439-1353
US

IV. Provider business mailing address

4236 JARMANN LN
SHAKOPEE MN
55379-5814
US

V. Phone/Fax

Practice location:
  • Phone: 952-491-6437
  • Fax:
Mailing address:
  • Phone: 612-208-3427
  • Fax: 612-238-4320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number33163
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: